Although techniques for treating periodontal (gum) disease can vary, they all boil down to one objective: remove the bacterial plaque and calculus (hardened plaque deposits) that cause the infection. The initial treatment usually involves two techniques known as scaling and root planing.

Scaling uses hand instruments, ultrasonic equipment or a combination of both to manually remove plaque and calculus from the tooth and root surfaces. Root planing takes it a step further by minutely “shaving” infected material from the root surfaces. While more invasive techniques (including surgery) may be needed, scaling and root planing are the first line of treatment for any recent diagnosis of gum disease.

In recent years, an adaptation to these treatments has emerged using the Nd: YAG laser. The laser uses a particular crystal that’s adaptable for many different types of surgery. In the case of gum disease, it’s been found as effective as traditional methods for removing the infected linings of periodontal pockets. Voids created by detaching gum tissues as bone loss occurs, enlarge the small natural gap between the teeth and gums, which fill with pus and other infected matter. Removing the diseased lining from these pockets reduces bacteria below the gum line and speeds healing.

Periodontal laser therapy may have one advantage over traditional treatments: less tissue damage and swelling, and hence reduced post-treatment discomfort. While some research seems to confirm this, more controlled studies are needed to render a verdict on this claim.

Regardless of whether you undergo traditional scaling and root planing or a laser alternative, the aim is the same — to bring the disease under control by removing plaque and calculus and reestablishing good daily oral hygiene practices. Stopping gum disease as soon as possible will help ensure you’ll have healthy teeth and gums for a long time.

Sometimes, looking at old pictures can really bring memories back to life. Just ask Stefani Germanotta—the pop diva better known as Lady Gaga. In one scene from the recent documentary Five Foot Two, as family members sort through headshots from her teen years, her father proclaims: "Here, this proves she had braces!"

"If I had kept that gap, then I would have even more problems with Madonna," Lady Gaga replies, referencing an ongoing feud between the two musical celebrities.

The photos of Gaga's teenage smile reveal that the singer of hits like "Born This Way" once had a noticeable gap (which dentists call a diastema) between her front teeth. This condition is common in children, but often becomes less conspicuous with age. It isn't necessarily a problem: Lots of well-known people have extra space in their smiles, including ex-football player and TV host Michael Strahan, actress Anna Paquin…and fellow pop superstar Madonna. It hasn't hurt any of their careers.

Yet others would prefer a smile without the gap. Fortunately, diastema in children is generally not difficult to fix. One of the easiest ways to do so is with traditional braces or clear aligners. These orthodontic appliances, usually worn for a period of months, can actually move the teeth into positions that look more pleasing in the smile and function better in the bite. For many people, orthodontic treatment is a part of their emergence from adolescence into adulthood.

Braces and aligners, along with other specialized orthodontic appliances, can also remedy many bite problems besides diastema. They can correct misaligned teeth and spacing irregularities, fix overbites and underbites, and take care of numerous other types of malocclusions (bite problems).

The American Association of Orthodontists recommends that kids get screened for orthodontic problems at age 7. Even if an issue is found, most won't get treatment at this age—but in some instances, it's possible that early intervention can save a great deal of time, money and effort later. For example, while the jaw is still developing, its growth can be guided with special appliances that can make future orthodontic treatment go quicker and easier.

Yet orthodontics isn't just for children—adults can wear braces too! As long as teeth and gums are healthy, there's no upper age limit on orthodontic treatment. Instead of traditional silver braces, many adults choose tooth-colored braces or clear aligners to complement their more professional appearance.

So if your child is at the age where screening is recommended—or if you're unhappy with your own smile—ask us whether orthodontics could help. But if you get into a rivalry with Madonna…you're on your own.

Canker sores, known medically as aphthous ulcers, are fairly common among people. Lasting for about a week or so, these mouth sores are usually more irritating than painful. But about a quarter of the population, especially women, frequently suffer from an acute form that doesn't often respond well to over-the-counter remedies.

A typical canker sore is usually round with a yellow-gray center ringed by a reddened "halo." They can be preceded by tingling or painful sensations at the site a few hours or so before breaking out. Recurrent aphthous stomatitis (RAS) is the more severe form of canker sore, often with outbreaks of multiple painful sores. While the more common sore is usually less than a centimeter in diameter, RAS sores are often much larger.

Canker sores often arise during periods of stress or anxiety, and seem to be connected with eating certain acidic foods like tomato sauce, citrus fruits or spicy dishes. RAS also seems to be related to underlying systemic conditions like vitamin deficiencies, anemia or digestive disorders. Besides managing diet and stress, people with regular canker sores and milder cases of RAS can often find relief with non-prescription numbing agents often found in stores and pharmacies.

For more severe RAS, though, you may need the help of your dentist or physician with treatments like prescription steroids or other medications that come in gel or rinse form or through injections. The goal of any treatment approach is to decrease pain severity and shorten healing times after an outbreak.

While most mouth sores, including RAS, aren't dangerous to your health, you should still take any sore seriously. You should especially seek medical evaluation if a sore doesn't heal after a couple of weeks, if they seem to come more frequently and are more severe, or if you don't seem to ever be without a sore in your mouth. These could indicate a serious underlying problem that needs to be addressed.

One thing's for sure: there are ways to ease your suffering if you have frequent bouts with regular canker sores or even RAS. Talk to your dentist about ways to minimize your discomfort from these irritating mouth sores.

If you would like more information on aphthous ulcers or canker sores, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Mouth Sores.”

If you’ve had issues with periodontal (gum) disease, no doubt a few things have changed for you. You may be seeing us for dental cleanings and checkups more frequently and you have to be extra diligent about your daily brushing and flossing.

There’s one other thing you may need to do: change your diet. Some of the foods you may be eating could work against you in your fight against gum disease. At the same time, increasing your intake of certain foods could boost your overall oral health.

The biggest culprits in the first category are carbohydrates, which make up almost half the average diet in the Western world, mainly as added sugar. Although carbohydrates help fuel the body, too much can increase inflammation—which also happens to be a primary cause of tissue damage related to gum disease.

Of course, we can’t paint too broad a brush because not all carbohydrates have the same effect on the body. Carbohydrates like sugar or processed items like bakery goods, white rice or mashed potatoes quickly convert to glucose (the actual sugar used by the body for energy) in the bloodstream and increase insulin levels, which can then lead to chronic inflammation. Complex or unprocessed carbohydrates like vegetables, nuts or whole grains take longer to digest and so convert to glucose slowly—a process which can actually hinder inflammation.

Eating less of the higher glycemic (the rate of glucose conversion entering the bloodstream) carbohydrates and more low glycemic foods will help reduce inflammation. And that’s good news for your gums. You should also add foods rich in vitamins C and D (cheese and other dairy products, for instance) and antioxidants to further protect your oral health.

Studies have shown that changing to a low-carbohydrate, anti-inflammatory diet can significantly reduce chronic inflammation in the body and improve gum health. Coupled with your other efforts at prevention, a better diet can go a long way in keeping gum disease at bay.

Gum recession is an all too common problem for millions of people that if left untreated could lead to tooth and bone loss. But the good news is not only can the process be stopped, much of the damage can also be repaired through periodontal plastic surgery.

Gum recession occurs when the gum tissue protecting the teeth detaches and draws back to expose the root surface. This exposure may result in a range of effects, from minor tooth sensitivity to eventual tooth loss. There are a number of causes for gum recession, including overaggressive brushing or flossing, biting habits or badly fitting dentures or appliances.

The most prominent cause, though, is periodontal (gum) disease, a bacterial infection triggered by plaque buildup on tooth surfaces due to poor oral hygiene. Fortunately, early gum disease is highly treatable by thoroughly cleaning tooth, root and gum surfaces of plaque and calculus (hardened plaque deposits), along with possible antibiotic therapy, to reduce the infection and promote tissue healing.

Unfortunately, advanced cases of gum recession may have already resulted in extensive damage to the tissues themselves. While disease treatment can stimulate some re-growth, some cases may require reconstructive surgery to repair and further rebuild the tissues.

There are several techniques periodontists (specialists in gums, bone and other dental support structures) or dentists with advanced training can perform to “re-model” recessed gum tissues. One of the major areas is placing tissue grafts (either from the patient or a human donor) at the site to encourage further tissue growth. Properly affixing a graft requires a great deal of training, skill and experience, especially in cases where the graft may need to be connected with adjoining tissues to establish a viable blood supply for the graft.

In skilled hands, a periodontal surgical procedure is fairly predictable with minimal discomfort afterward. And the lasting effects are well-worth it — not only will your health benefit from restored gum tissue and greater protection for your teeth, you’ll also enjoy a more attractive smile.

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